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DOI: 10.4103/2278-9626.105355
Management of third molar teeth from an endodontic perspective

Abstract
Third molar teeth are subject to many dental complications because of their most posterior location, aberrant occlusal anatomy and abnormal eruption patterns. Owing to these anatomical limitations, their extraction remains the treatment of choice for many dental practitioners. Despite being a common dental procedure, minimum intervention and retaining every functional component of the dental arch are of prime importance in contemporary dental practice. As such, this review aims to discuss the application of this conservative approach on third molar teeth from an endodontic perspective. The internal and external root anatomy of maxillary and mandibular third molars and their relation to the surrounding vital structures are described. These anatomical landmarks are then correlated to the decision making for endodontic treatment strategies of third molars. In addition, the recommended guidelines that should be followed while commencing endodontic treatment in third molars are outlined.
Publication History
Article published online:
01 November 2021
© 2012. European Journal of General Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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References
- 1 Woelfel JB, Scheid RC. Dental anatomy Its relevance to dentistry. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 178-220.
- 2 Westesson PL, Carlsson LE. Anatomy of mandibular third molars. A comparison between radiographic appearance and clinical observations. Oral Surg Oral Med Oral Pathol 1980;49:90-4.
- 3 Plotino G. A mandibular third molar with three mesial roots: A case report. J Endod 2008;34:224-6.
- 4 Sidow SJ, West LA, Liewehr FR, Loushine RJ. Root canal morphology of human maxillary and mandibular third molars. J Endod 2000;26:675-8.
- 5 Keinan D, Nuni E, Slutzky-Goldberg I. Is a C-shaped configuration possible in teeth other than mandibular molars? Quintessence Int 2009;40:541-3.
- 6 Nimigean V, Nimigean VR, Sãlãvãstru DI. A rare variant of internal anatomy of a third mandibular molar: A case report. Rom J Morphol Embryol 2011;52:691-3.
- 7 Nelson ST, Ash MM. Wheeler′s dental anatomy, physiology and occlusion. 9 th ed. St. Louis: Saunders Elservier; 2010. p. 184-8.
- 8 Ahmed HMA, Abbott PV. Accessory roots in maxillary molar teeth: a review and endodontic considerations. Aust Dent J 2012;57:123-31.
- 9 Guerisoli DM, de Souza RA, de Sousa Neto MD, Silva RG, Pecora JD. External and internal anatomy of third molars. Braz Dent J 1998;9:91-4.
- 10 Sert S, Sahinkesen G, Topcu FT, Eroglu SE, Oktay EA. Root canal configurations of third molar teeth. A comparison with first and second molars in the Turkish population. Aust Endod J 2011;37:109-17.
- 11 Ng YL, Aung TH, Alavi A, Gulabivala K. Root and canal morphology of Burmese maxillary molars. Int Endod J 2001;34:620-30.
- 12 Alavi AM, Opasanon A, Ng YL, Gulabivala K. Root and canal morphology of Thai maxillary molars. Int Endod J 2002;35:478-85.
- 13 Èosić J, Galić N, Njemirovskij V, Vodanović M. Root Canal Anatomy of Third Molars. In: PEF/ IADR International Dental Research Meeting. London; 2008.
- 14 Pécora JD, Woelfel JB, Sousa Neto MD. Morphologic study of the maxillary molars. 1. External anatomy. Braz Dent J 1991;2:45-50.
- 15 Pécora JD, Woelfel JB, Sousa Neto MD, Issa EP. Morphologic study of the maxillary molars. Part II: Internal anatomy. Braz Dent J 1992;3:53-7.
- 16 Cleghorn BM, Christie WH, Dong CC. Root and root canal morphology of the human permanent maxillary first molar: A literature review. J Endod 2006;32:813-21.
- 17 Verma P, Love RM. A Micro CT study of the mesiobuccal root canal morphology of the maxillary first molar tooth. Int Endod J 2010;44:210-7.
- 18 Green D. Double canals in single roots. Oral Surg Oral Med Oral Pathol 1973;35:689-96.
- 19 Stropko JJ. Canal morphology of maxillary molars: Clinical observations of canal configurations. J Endod 1999;25:446-50.
- 20 Woelfel JB, Scheid RC. Dental anatomy its relevance to dentistry. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 78-107.
- 21 Green D. Morphology of the pulp cavity of the permanent teeth. Oral Surg Oral Med Oral Pathol 1955;8:743-59.
- 22 Nelson ST, Ash MM. Wheeler′s dental anatomy, physiology and occlusion. 9 th edn ed. St. Louis: Saunders Elservier; 2010. p. 203-7.
- 23 Gulabivala K, Opasanon A, Ng YL, Alavi A. Root and canal morphology of Thai mandibular molars. Int Endod J 2002;35:56-62.
- 24 Gulabivala K, Aung TH, Alavi A, Ng YL. Root and canal morphology of Burmese mandibular molars. Int Endod J 2001;34:359-70.
- 25 Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol 1972;33:101-10.
- 26 Jafarzadeh H, Abbott PV. Dilaceration: Review of an endodontic challenge. J Endod 2007;33:1025-30.
- 27 Hamasha AA, Al-Khateeb T, Darwazeh A. Prevalence of dilaceration in Jordanian adults. Int Endod J 2002;35:910-2.
- 28 Malèić A, Jukić S, Brzović V, Miletić I, Pelivan I, Anić I. Prevalence of root dilaceration in adult dental patients in Croatia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:104-9.
- 29 Udoye CI, Jafarzadeh H. Dilaceration among Nigerians: Prevalence, distribution, and its relationship with trauma. Dent Traumatol 2009;25:439-41.
- 30 Miloglu O, Cakici F, Caglayan F, Yilmaz AB, Demirkaya F. The prevalence of root dilacerations in a Turkish population. Med Oral Patol Oral Cir Bucal 2010;15:e441-4.
- 31 Kannan SK, Suganya, Santharam H. Supernumerary roots. Indian J Dent Res 2002;13:116-9.
- 32 Hilú RE, Zmener O. Endodontic management of two mandibular third molars with C-shaped root canals: A case report. Endod Pract 2007;10:21-4.
- 33 Hou GL, Tsai CC. Fusion of maxillary third and supernumerary fourth molars. Case report. Aust Dent J 1989;34:219-22.
- 34 Rotstein I, Moshonov J, Cohenca N. Endodontic therapy for a fused mandibular molar. Endod Dent Traumatol 1997;13:149-51.
- 35 Turell IL, Zmener O. Endodontic therapy in a fused mandibular molar. J Endod 1999;25:208-9.
- 36 Turell IL, Zmener O. Endodontic management of a mandibular third molar fused with a fourth molar. Int Endod J 1999;32:229-31.
- 37 Zeylabi A, Shirani F, Heidari F, Farhad AR. Endodontic management of a fused mandibular third molar and distomolar: A case report. Aust Endod J 2010;36:29-31.
- 38 Goldberg JM, Gross M, Rankow H. Endodontic therapy involving fused mandibular second and third molars. J Endod 1985;11:346-7.
- 39 Hemmig SB. Third and fourth molar fusion. Oral Surg Oral Med Oral Pathol 1979;48:572.
- 40 Chen HS, Huang YL. Fusion of third and fourth mandibular molars? Oral Surg Oral Med Oral Pathol 1992;73:767.
- 41 Celik E, Aydinlik E. Effect of a dilacerated root on stress distribution to the tooth and supporting tissues. J Prosthet Dent 1991;65:771-7.
- 42 Roberts WE. Bone physiology, metabolism and biomechanics in orthodontic practice. In: Graber LW, Vanarsdall RL, Vig KW, editors. Orthodontics current principles and techniques. 5 th ed. Philadelphia: Elservier; 2012. p. 287-343.
- 43 Esteves T, Ramos AL, Pereira CM, Hidalgo MM. Orthodontic root resorption of endodontically treated teeth. J Endod 2007;33:119-22.
- 44 Nair MK, Nair UP. Digital and advanced imaging in endodontics: A review. J Endod 2007;33:1-6.
- 45 Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod 2010;36:1547-51.
- 46 Krithikadatta J, Kottoor J, Karumaran CS, Rajan G. Mandibular first molar having an unusual mesial root canal morphology with contradictory cone-beam computed tomography findings: A case report. J Endod 2010;36:1712-6.
- 47 White SC, Pharoah MJ. Oral radiology Principles and interpretation. 6 th ed. St. Louis: Mosby; 2009. p. 150.
- 48 Whaites E. Essentials of dental radiography and radiology. 4 th ed: Philadelphia: Churchill Livingstone Elsevier; 2007. p. 117.
- 49 Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: A review. Int Endod J 2002;35:127-41.
- 50 Kilic C, Kamburoglu K, Yuksel SP, Ozen T. An assessment of the relationship between the maxillary sinus floor and the maxillary posterior teeth root tips using dental cone-beam computerized tomography. Eur J Dent 2010;4:462-7.
- 51 Tyndall DA, Kohltfarber H. Application of cone beam volumetric tomography in endodontics. Aust Dent J 2012;57 Suppl 1:72-81.
- 52 Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: A review of the literature. J Oral Maxillofac Surg 2010;68:1384-91.
- 53 Suomalainen A, Venta I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:276-84.
- 54 Hülsmann M, Rödig T, Nordmeyer S. Complications during root canal irrigation. Endod Top 2009;16:27-63.
- 55 Gluskin AH. Mishaps and serious complications in endodontic obturation. Endod Top 2005;12:52-70.
- 56 Nayak RN, Hiremath S, Shaikh S, Nayak AR. Dysesthesia with pain due to a broken endodontic instrument lodged in the mandibular canal--a simple deroofing technique for its retrieval: Case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e48-51.
- 57 González-Martín M, Torres-Lagares D, Gutiérrez-Pérez JL, Segura-Egea JJ. Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal. J Endod 2010;36:1419-21.
- 58 Giardino L, Pontieri F, Savoldi E, Tallarigo F. Aspergillus mycetoma of the maxillary sinus secondary to overfilling of a root canal. J Endod 2006;32:692-4.
- 59 Khongkhunthian P, Reichart PA. Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: Report of two cases. J Endod 2001;27:476-8.
- 60 Zehnder M. Root canal irrigants. J Endod 2006;32:389-98.
- 61 Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in endodontics. Dent Clin North Am 2010;54:291-312.
- 62 Mitchell RP, Baumgartner JC, Sedgley CM. Apical extrusion of sodium hypochlorite using different root canal irrigation systems. J Endod 2011;37:1677-81.
- 63 Boutsioukis C, Verhaagen B, Versluis M, Kastrinakis E, Wesselink PR, van der Sluis LW. Evaluation of irrigant flow in the root canal using different needle types by an unsteady computational fluid dynamics model. J Endod 2010;36:875-9.
- 64 Gondim E, Jr., Setzer FC, Dos Carmo CB, Kim S. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. J Endod 2010;36:1295-301.
- 65 Fava LR. Calcium hydroxide paste in the maxillary sinus: A case report. Int Endod J 1993;26:306-10.
- 66 Liston PN, Walters RF. Foreign bodies in the maxillary antrum: A case report. Aust Dent J 2002;47:344-6.
- 67 Scolozzi P, Lombardi T, Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: Report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:625-31.
- 68 Tilotta-Yasukawa F, Millot S, El Haddioui A, Bravetti P, Gaudy JF. Labiomandibular paresthesia caused by endodontic treatment: An anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e47-59.
- 69 Brkić A, Gürkan-Köseoğlu B, Olgac V. Surgical approach to iatrogenic complications of endodontic therapy: A report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e50-3.
- 70 Ahonen M, Tjäderhane L. Endodontic-related paresthesia: A case report and literature review. J Endod 2011;37:1460-4.
- 71 Escoda-Francoli J, Canalda-Sahli C, Soler A, Figueiredo R, Gay-Escoda C. Inferior alveolar nerve damage because of overextended endodontic material: A problem of sealer cement biocompatibility? J Endod 2007;33:1484-9.
- 72 Fanibunda K, Whitworth J, Steele J. The management of thermomechanically compacted gutta percha extrusion in the inferior dental canal. Br Dent J 1998;184:330-2.
- 73 Yamaguchi K, Matsunaga T, Hayashi Y. Gross extrusion of endodontic obturation materials into the maxillary sinus: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:131-4.
- 74 Davis RD, Marshall JG, Baumgartner JC. Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments. J Endod 2002;28:438-42.
- 75 Weine FS, Healey HJ, Gerstein H, Evanson L. Pre-curved files and incremental instrumentation for root canal enlargement. J Can Dent Assoc 1970;36:155-7.
- 76 Ahmed HMA, Luddin N. Endodontic management of a maxillary molar using a modified incremental instrumentation technique. Int J Dent Clin 2011;3:78-9.
- 77 Solomonov M, Paque F, Fan B, Eilat Y, Berman LH. The challenge of C-shaped canal systems: A comparative study of the self-adjusting file and ProTaper. J Endod 2012;38:209-14.
- 78 Jafarzadeh H, Wu YN. The C-shaped root canal configuration: A review. J Endod 2007;33:517-23.
- 79 Kottoor J, Velmurugan N, Ballal S, Roy A. Four-rooted maxillary first molar having C-shaped palatal root canal morphology evaluated using cone-beam computerized tomography: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e41-5.
- 80 Fan B, Gao Y, Fan W, Gutmann JL. Identification of a C-shaped canal system in mandibular second molars-part II: the effect of bone image superimposition and intraradicular contrast medium on radiograph interpretation. J Endod 2008;34:160-5.
- 81 Fan B, Min Y, Lu G, Yang J, Cheung GS, Gutmann JL. Negotiation of C-shaped canal systems in mandibular second molars. J Endod 2009;35:1003-8.
- 82 Min Y, Fan B, Cheung GS, Gutmann JL, Fan M. C-shaped canal system in mandibular second molars Part III: The morphology of the pulp chamber floor. J Endod 2006;32:1155-9.
- 83 Yin X, Cheung GS, Zhang C, Masuda YM, Kimura Y, Matsumoto K. Micro-computed tomographic comparison of nickel-titanium rotary versus traditional instruments in C-shaped root canal system. J Endod 2010;36:708-12.
- 84 Walid N. The use of two pluggers for the obturation of an uncommon C-shaped canal. J Endod 2000;26:422-4.
- 85 Tabarsi B, Parirokh M, Eghbal MJ, Haghdoost AA, Torabzadeh H, Asgary S. A comparative study of dental pulp response to several pulpotomy agents. Int Endod J 2010;43:565-71.
- 86 Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. J Endod 2011;37:581-7.
- 87 Asgary S, Ehsani S. Permanent molar pulpotomy with a new endodontic cement: A case series. J Conserv Dent 2009;12:31-6.
- 88 Nosrat A, Asgary S. Apexogenesis of a symptomatic molar with calcium enriched mixture. Int Endod J 2010;43:940-4.
- 89 Asgary S. Calcium-enriched mixture pulpotomy of a human permanent molar with irreversible pulpitis and condensing apical periodontitis. J Conserv Dent 2011;14:90-3.
- 90 Asgary S, Eghbal MJ, Ghoddusi J, Yazdani S. One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: An ongoing multicenter, randomized, non-inferiority clinical trial. Clin Oral Investig 2012. Ahead of print. DOI: 10.1007/s00784-012-0712-6.
- 91 Asgary S, Eghbal MJ. The effect of pulpotomy using a calcium-enriched mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: A randomized clinical trial. Odontology 2010;98:126-33.
- 92 Parirokh M, Torabinejad M. Mineral trioxide aggregate: A comprehensive literature review--Part III: Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-13.
- 93 Mendes RA, Rocha G. Mandibular third molar autotransplantation--literature review with clinical cases. J Can Dent Assoc 2004;70:761-6.
- 94 Park JH, Tai K, Hayashi D. Tooth autotransplantation as a treatment option: A review. J Clin Pediatr Dent 2011;35:129-35.
- 95 Bauss O, Schilke R, Fenske C, Engelke W, Kiliaridis S. Autotransplantation of immature third molars: influence of different splinting methods and fixation periods. Dent Traumatol 2002;18:322-8.
- 96 Mejàre B, Wannfors K, Jansson L. A prospective study on transplantation of third molars with complete root formation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:231-8.
- 97 Reich PP. Autogenous transplantation of maxillary and mandibular molars. J Oral Maxillofac Surg 2008;66:2314-7.
- 98 Waikakul A, Punwutikorn J, Kasetsuwan J, Korsuwannawong S. Alveolar bone changes in autogenous tooth transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e1-7.
- 99 Teixeira CS, Pasternak B Jr., Vansan LP, Sousa-Neto MD. Autogenous transplantation of teeth with complete root formation: Two case reports. Int Endod J 2006;39:977-85.
- 100 Tsurumachi T, Kakehashi Y. Autotransplantation of a maxillary third molar to replace a maxillary premolar with vertical root fracture. Int Endod J 2007;40:970-8.
- 101 Laureys W, Beele H, Cornelissen R, Dermaut L. Revascularization after cryopreservation and autotransplantation of immature and mature apicoectomized teeth. Am J Orthod Dentofacial Orthop 2001;119:346-52.
- 102 Temmerman L, De Pauw GA, Beele H, Dermaut LR. Tooth transplantation and cryopreservation: State of the art. Am J Orthod Dentofacial Orthop 2006;129:691-5.
- 103 Temmerman L, Vral A, Meire M, Verbeeck RM, Deschepper E, Dermaut LR, et al. Pulpal regeneration and root development after subcutaneous transplantation of cryopreserved immature teeth in rats. Cryobiology 2012;64:81-90.
- 104 Clokie CM, Yau DM, Chano L. Autogenous tooth transplantation: An alternative to dental implant placement? J Can Dent Assoc 2001;67:92-6.